{
"Npi": {
"NPI": "1518145366",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JESSE KO, MD, PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
"OtherFirstName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "20945 45TH RD FL 1",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BAYSIDE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11361-3233",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-423-7200",
"MailingAddressFaxNumber": "718-224-8727",
"FirstLinePracticeLocationAddress": "20945 45TH RD FL 1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BAYSIDE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11361-3233",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-423-7200",
"PracticeLocationAddressFaxNumber": "718-224-8727",
"EnumerationDate": "02/04/2008",
"LastUpdateDate": "08/01/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KO",
"AuthorizedOfficialFirstName": "JESSE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "718-423-7200",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "213571",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}